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Nasoduodenal versus nasogastric feeding in the very low birthweight infant
Insights
Continuous nasoduodenal feeding offers significant advantages for very low birthweight infants, improving caloric intake, weight gain, and safety compared to nasogastric methods. This method ensures quicker nutritional support and reduces risks like aspiration pneumonia.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Infant Feeding Practices
Background:
- Very low birthweight infants (<1,300 gm) require specialized nutritional support.
- Continuous nasogastric feeding is a common method but may have limitations.
- Optimizing feeding methods is crucial for infant growth and development.
Purpose of the Study:
- To evaluate the practicality, effectiveness, and safety of continuous nasoduodenal (ND) infusion versus continuous nasogastric (NG) feeding in very low birthweight infants.
- To compare caloric intake, weight gain, and complication rates between ND and NG feeding groups.
- To assess the time to achieve adequate caloric intake with each feeding method.
Main Methods:
- A comparative study assessing continuous nasoduodenal infusion against continuous nasogastric feeding.
- Inclusion of very low birthweight infants (less than 1,300 gm).
- Monitoring of caloric intake, average weight gain, and incidence of complications such as aspiration pneumonia.
Main Results:
- Nasoduodenal feeding demonstrated a clear advantage in caloric intake (131 cal/kg/day vs. 106 cal/kg/day) and average weight gain (16 gm/day vs. 10 gm/day) compared to nasogastric feeding.
- Adequate caloric intake was achieved faster with nasoduodenal feeding (48-72 hours) versus nasogastric feeding (1 week).
- No aspiration events occurred with nasoduodenal tubes, whereas two cases of aspiration pneumonia were linked to nasogastric tubes; no severe complications like necrotizing enterocolitis were observed with ND feeding.
Conclusions:
- Continuous nasoduodenal infusion is a more effective and safer method for feeding very low birthweight infants compared to continuous nasogastric feeding.
- Nasoduodenal feeding facilitates more rapid nutritional support and improved growth outcomes.
- The safety profile of nasoduodenal feeding is superior, with a reduced risk of aspiration and other serious gastrointestinal complications.
Abstract:
The practicality, effectiveness, and safety of feeding very low birthweight infants (less than 1,300 gm) by continuous nasoduodenal infusion was assessed by comparison with continuous nasogastric feeding. The nasoduodenal group appeared to have a clear advantage over the nasogastric group for the overall period in terms of caloric intake (131 cal/kg/day vs. 106 cal/kg/day), average weight gain (16 gm/day vs. 10 gm/day), and safety. This advantage was even more striking in the first two weeks of life. A caloric intake of 120 cal/kg/day could be reached within 48 to 72 hours after tube placement in the nasoduodenal group but only after a week in the nasogastric group. Nasoduodenal feeding resulted in faster weight gain than comparable published data on conventional feeding, peripheral intravenous alimentation, and parenteral alimentation. There were no cases of aspiration associated with tubes placed in the duodenum whereas two cases of aspiration pneumonia were associated with tubes placed in the stomach. With the tip of the catheter in the duodenum, none of the complications reported with nasojejunal tubes (intussusception, perforation, or necrotizing enterocolitis) were seen, either in the initial pilot study reported here or in 50 additional infants.